Above: Senior members of the Knickerbikers prepare for their regular Saturday ride. May 13, 2017

Injuries among children and teens riding bicycles have plummeted in California over the past decade, but at the other end of the age spectrum there’s worrisome news.

Cyclists 55 and older are more often getting into crashes that result in a visit to an emergency room. Compared with younger riders, injuries in seniors also tend to be more serious and more likely to provoke an admission to the hospital.

Dr. Michael Sise, chief of staff at Scripps Mercy Hospital and former head of the hospital’s trauma center, didn’t have to be told there’s been an increase in seniors getting into trouble on their bicycles. He’s seen it.

“As we age, we lose bone mass and we’re not as resilient,” he said. Seniors “are more likely to get fractures from the same trauma that a younger person wouldn’t necessarily get a fracture.”

Bike sharing, bike paths and biking to work and for pleasure are becoming ever more popular in health-conscious California, where people feel good about trading in four wheels that pollute for two that are powered by calories and muscle.

Injury data is collected from hospitals by the California Office of Statewide Health Planning and Development and was analyzed by inewsource.

Here are some San Diego stats over the past decade:

-For senior cyclists whose injuries required hospital care, the older the age bracket, the more likely they were to be admitted as an inpatient, indicating more serious injuries. For those 45 to 49, 16.2 percent were admitted; for those 50 to 54, 19.4 percent were admitted, and for seniors 55 and older, 23.3 percent were admitted.

–The rate of bicycle-related injuries resulting in a trip to the emergency room for people between 50 and 54, adjusting for population growth, grew from 11.60 to 15.32 injuries per 10,000 residents between 2007 and 2015.

–Rates of bicycle injuries in children prompting a trip to the hospital dropped dramatically from 2007 to 2015.

–Although the rates declined, the largest numbers of injuries throughout 2015 were in the age brackets 10-14 and 15-19, which saw 5,071, and 4,207 respectively.

These trends also were seen in other large counties: Alameda, Contra Costa, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Francisco and Santa Clara.

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Injuries among children and teens riding bicycles have plummeted in California over the past decade, but at the other end of the age spectrum there’s worrisome news.

Bicycling advocates said they weren’t entirely sure why the rates of injury had dropped so dramatically in children and teens, and why the rates in seniors have seen an upward trend.

Linda Khamoushian, communications manager for the California Bicycle Coalition, which promotes more and safer bicycling as a lifestyle, said that the data should not be construed to mean that bicycling is not safe.

She pointed to the U.S. Census Bureau’s American Community Survey, which showed “road share” bicycle rate counts are way up, and in fact doubled between 2000 and 2008-2012.

It’s hard to know if seniors are clocking a lot more bicycle miles now, but they probably are. And if so, the per mile rate of injuries among seniors is probably lower, she noted.

Emergency department visits resulting from adult bicycle trauma have increased dramatically between 1997 and 2013, as have costs of medical care, according to a June article in the journal Injury Prevention, which looked at data from a sample of 100 U.S. hospitals. But bicycle miles ridden by people 45 and older rose by 91 percent, the researchers wrote.

Ken King, leader of the long-standing San Diego Knickerbikers bicycle club, noted that when he hears about cyclists getting injured, it’s usually that a cyclist rode into a pothole, crashed against a curb, or tripped on a railroad track rather than collided with a motor vehicle. Many involve cyclists crashing into other cyclists. When motor vehicles are involved, he hears, it’s often because of distracted drivers talking on their phones or texting, which makes them even less aware of a cyclist.

Injuries also happen when drivers make a rapid right turn in front of a cyclist, who are smaller and harder to see than motor vehicles.

Mary Beth Moran, program manager with the Center for Healthier Communities at Rady Children’s Hospital, attributed the decline in childhood bicycle injuries in part to a gradual impact from law that took effect in 2003 requiring any bicycle rider under age 18 to wear a helmet.

But also effective, she said, is a federally funded Safe Routes to School program, which teaches skills to parents and children in targeted schools to ride and walk safely with programs like “bike rodeos” and helmet distribution.

Those have “dramatically decreased injuries,” she said.

Drugs, alcohol, traffic

Sise emphasized that the older injured riders aren’t just those riding for sport. Rather, a high percentage are older patients use their bicycles as their primary mode of transportation, frequently because they lost their driver’s licenses due to drug or alcohol abuse, he said.

Sise said Scripps Mercy’s patient data for 2016 showed that 25 percent of those brought in for serious bicycle-related injuries tested positive for drugs or alcohol. Often, they’re not wearing a helmet, he said.

Older cyclists also may be on medications that increase their risk of harm. For example, Sise recently admitted an 82-year-old injured bicyclist who was on a blood thinner. Those drugs put patients at significant risk of bleeding in any injury. “The big risk is a head bleed, where you hit your head, which causes a hemorrhage in the brain,” he said.

Sise said programs that encourage more people to bicycle to work for exercise and energy conservation are wonderful, but riders should appreciate that traffic has changed, especially on dense city streets.

First, he said, drivers can’t see bicyclists in congestion. “They see other cars, but they don’t see you. No matter how good a bike rider you are, if you’re sharing the road with cars that don’t see you, you’re in danger.”

Second, newer cars with air bags and restraints are much safer, so “you can get clobbered at a high rate of speed and basically walk away,” Sise continued. “But you have a bike crash at 5 or 10 miles an hour, and have a fatal head injury because you basically are the crumple zone.”

Frederick Dudek, a lawyer who said he specializes in cycling injuries in older San Diegans, echoed Sise’s view. He said that overwhelmingly, the incidents he sees occur in intersections. “It’s lane drift and downtown, there are more intersections and a lot more traffic.”

Sise has “a personal stake” in the issue of cycling safety because he’s seen six friends get seriously injured while bike riding.

“A couple couldn’t work for six months because of cognitive impairment from a severe concussion.” These included colleagues, physicians and accomplished road racers who wore helmets. A trauma surgeon and good friend, “was killed while riding his bike to work.”

Sise said he doesn’t ride anymore. “I loved riding,” he added, “but if you ride to work, if it’s your primary mode of transportation, it’s dangerous. There’s no two ways about it,” he said.

–OSHPD data for hospital inpatient admissions were collected for the first six months of 2016, and were extrapolated for the last six months.